NEW YORK (Reuters Health) – One in five of patients with congenital heart disease need surgery in adulthood, and reoperations make up about 40% of these surgeries, according to an analysis of data from the Dutch Congenital Corvitia (CONCOR) registry for adults with congenital heart disease.

“The high rate of reoperations supports the hypothesis that corrective surgery is not necessarily curative surgery, and thorough follow-up is needed in these patients,” researchers say.

The data also show that men with congenital heart disease are more apt to need surgery in adulthood and have a consistently worse long-term survival after reoperations in adulthood than women.

Due to major advances in cardiothoracic surgery over the years, the vast majority of newborns with congenital heart disease now survive to adulthood, Dr. Barbara Mulder from Academic Medical Centre, Amsterdam, the Netherlands, note in a report online in the journal Circulation.

However, a significant number of them will require cardiovascular surgery at some point in adulthood, either for first corrective surgery or for reoperations to treat residual defects or long-term complications.

Dr. Mulder and colleagues used the CONCOR registry to get a better handle on cardiovascular surgery for congenital heart disease in adulthood. They identified and included in their analysis 10,300 adults with a median age of 33 years at inclusion.

During a median follow-up of 15 years, 2,015 of these individuals, or 20%, had surgery for their disease; in 812 (40%) it was a reoperation.

“A large proportion of patients (70%) who required surgery in adulthood were operated on for the first time ever,” the researchers report. These patients were mostly adults with atrial septal defect and aortic stenosis, a finding that supports the literature.

One third of Marfan patients had their first surgery in adulthood, which also is in agreement with the previously reported data, the authors note. Focusing on reoperations, patients with tetralogy of Fallot formed the largest subgroup needing reoperations in adulthood.

Overall, long-term survival after reoperations in adulthood depended on the number of past surgeries. Although long-term survival after a patient’s first and second surgeries is “relatively high,” long-term survival after three or more surgeries is reduced, the authors say.

The data also suggest that young adult men with congenital heart disease have a 40% higher change of undergoing first surgery and a 20% higher change of undergoing reoperations than women. Furthermore, men have a 2-fold higher risk of mortality after reoperations in adulthood compared to women.

“This study supports the existing evidence for sex differences in the prognosis of adults with congenital heart disease, and these findings underscore the need for further research on the mechanisms underlying these differences,” a clinical perspective piece published with the study notes.

Regarding the sex differences in treatment, Dr. Mulder’s team says their study can’t exclude the possibility that women are “undertreated or alternatively that men are overtreated as has been suggested in other cardiovascular diseases.”

Reference:

Surgery in Adults With Congenital Heart Disease

Circulation 2011;124.